The URL can be used to link to this page

Home My WebLink About4273DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 83.82 -2 -49 BOX 32 04273 R 5,1JXRLU - A1MEL*�,:1VF>ED,= . $, ASP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF -HEALTH 1 Geneva Road, Brewster, New York 10509 November 14, 2005 County Executive David Bellel 22.Sherman Street / Brooklyn, New York 11215 V Re: Revised Well Permit Application for Bellel Property — 19 Mathes Street Town of Putnam Valley Dear Mr. Bellel: This Department has approved the revised well location for the well on Permit # W -5 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 50 feet from on -site and/or adjacent subsurface sewage �......:.: ,- . treatment system: areas.. -- - = 3. The well shall be installed with a minimum of 87 feet of casing 4. An ultra- violet light disinfection unit shall be installed on the incoming well line to the dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. .6. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions concerning this matter, please feel free to contact this office. MJB:cj cc: C. Santos, (T) Putnam Valley Insite Engineering Respectfully, Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 SHERLITA AMLER, MD, MS, FAAP ?�kgr LORETTA MOLINARI, RN, MSN Associate Commissioner of Health March 3, 2005 David Bellel 22 Sherman Street Brooklyn, NY 11215 Dear Mr. Bellel: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT J. BONDI Executive . Re: Well Permit Application for Bellel Property — 19 Mathes Street (T) Putnam Valley This Department has approved the well permit for Well #W5 -05 at the above referenced site. Please be advised that if site conditions and/or site plans change and/or are revised, thereby compromising the approved separation distances, siting approval of the well must be re- approved by this Department. This letter shall serve as record of approval and by initiating construction of the well covered by this approval of plans, the applicant accepts and agrees to abide by and conform to the following: 1. The well location shall be survey located and staked prior to drilling. 2. The proposed well is approved 60 feet from on -site and/or adjacent subsurface sewage treatment system areas. - - -° - 3•. . The ,well--shali- .be- .i.nstalled with- a:,minimurn of 80 •feet -of _casm. 4. An ultra- violet light disinfection unit 'shelf be "installed- on*the incoming well line ' to the dwelling. 5. A water sample shall be collected and analyzed for coliform bacteria after the well is drilled. The sample result is to be submitted to this Department along with the well completion report within 30 days of completion of the water well. 6. All necessary Town permits for the installation of the well are required to be issued prior to well construction. Should you have any questions, please contact this office. Michael J/Budzifiskil PE MJB :cw Cc: C. Santos, (T) Putnam Valley Insite Engineering Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention /Preschool (845) 278 -6014 Fax (845) 278 -6648 . PUTNAM COUNTY DEPARTMENT OF HEALTH �-3 3 DIVISION OF ENVIRONMENTAL HEALTH SERVICES Ic please print or type PCHD Permit # W p 05 on: Street Address: To i Tax Grid # e3 �--'- —Lt ci Map Block Lot(s) Well Owner: .4- Name: Address: j Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought gpm # People Served ----.- Est. of Daily Usage �tgal. Reason for_ Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason �. for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ..................................:.............. ............................... Yes No _ ......................... ............................... Is well located in a realty subdivision? ............. Yes No Name of,,�ubdivision Lot No. Water_W -b11ISntractor: 7 M> Address: Is'Piiblic. Watier Supply available to site? ............. ............................... ..................... Yes No , Name of Pic Water Supply: Town/Village Distance to-property from nearest water main: 000 � Proposed %11 location & sources of contamination to be provided on separate sheet/plan. i.4. T* -� 1� ��'��`S C � -.. ... T.-= �.;': � _ � " _ 1.+..�..ce -- � _.� - -.s ¢_ ► -_ .. ...o -V BOO .�A aim 4s ++ Dd4_ .4 \) App"licanf Signature. PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. Date of Issue 51 ?J Permit Date of Expiration Title: _ Permit is Non- Transfe rab e White copy- HD file; Yellow copy -Building Inspector; Pink copy - Owne(}; Orange copy -Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES / ) ICI A'I`ION• TO; CQNS.TR CT.rA �VfATER.WELJ�. , y.4 a...r. e.,'i" .> r ' —��.,. .. ra. •. _ � .,r •re. �6ss."x...a please print or type PCHD Permit on: Street Address: To (/Map Tax Grid #-� ; Block Lot(s) Well Owner: Nam-3 e: Address: Use of Well: Residential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought . S gpm #People Served --- -Est. of Daily Usage �Zgal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling New Supply (new dwelling) Deepen Existing Well Detailed Reason dy or for Drilling Well Type . Drilled Driven f Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is wall located in a realty subdivision? ...................................... ............................... Yes No Name of, jsubdivision Lot No. Wate.'r;:Wll &ontractor:� Address: Is:PuJplid, Water Supply available to site? .................................. ............................... Yes No Name of Plic Water Supply: Town/Village Digtance tWoperty from nearest water main: 00 ' Proposed )A11 location & sources of contamination to be provided on separate sheet/plan. LQ Dated d , _ ` Applicant PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well'construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the ;well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water well driller certified by Putnam County. i Date of Issue �J 0.5 Date of Expiration Permit is Non- Transfe rib e Permi Title: White copy - HD file; Yellow copy - Building Inspector; Form WP -97 Ir W SHERLITA AMLER, MD, MS, FAAP . . .. . �L -:�� IV -7- LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH I Geneva Road, Brewster, New York 10509 ROBERT J.BONDI Februaryir,'2005 Mr. David Bellel Ff 19 Mathes Street ? Putnam Valley, NY 10579 � c�.�C Dear Mr. Beffel, Enclosed please find the well application which you submitted to this Department a few days ago. We are returning it due to the fact that some information was omitted. Please complete ... -theilaim marked with-the -red asterisk and return.toj-11iaDep4rtme jijt.fpr-..handhng. Please. send it to my,040pi; 'x"anneNa"6]ifan6. so ,I can forward it al ong with the othdr." papers you submitted to Mr. Budzinski. Your attention to this matter is appreciated. Sincerely, :M Water Supply Section (945) 225-5186 Fax(845)225-5418 Environmental Health (845) 278-6130 Fax(845)278-7921 Nursing Services (845) 278-6558 WIC(845)278-6678 Fax(845)278-6085 Early Intervention/Preschool (845) 278-6014 Fax (845) 278-6648 PERMIT # MAN OF PU1'NAM VALLEY. WELL' PERMIT APPLICATION R a OWNER T.M.#off - MAILING ADDRESS 5 , , PHONE # LOCATION OF PROPERTY NEAREST INTERSECTION SUBDIVISION LOT# ZONING SIZE OF LOT (SQ.FT.) HEIGHT DESCRIPTION OF CONSTRUCTION EST. COST I, , do hereby agree that the Building Code will be complied with whether the same is specified or not; as well as the Sanitary Code, Plumbing Code and any other Law, rule or regulation affecting said structure of building. The Inspector shall have the right to enter any premises during the daytime, at reasonable hours, in the course of his duty. All work shall be performed in accordance with the construction documents submitted and accepted as part of this application, unless changes .to those documents have been approved by the Code Enforcement Officer responsible for enforcement of the code. DATE: (Owner or Agent) .., - C;. %M- W1 .WELL D EW&N.i ME•&L10Ef4SE* approve a . Code: and t the State;.:C >.1 .DATE: PAID: blot plan to conform to the Zoning Ordinances of the Town of Putnam Valley and hereby subject to further approval and compliance with the reqbirernenff.6f the State Building Code of this Town, Code as well as an other law, rule or re i 'a��Y �, g � Y regulations of ... pity, Town or Bureau or Department hereof. o I BUILDING AND ZONING INSPECTOR Well Permit $__15.00 Total $_15.00 ZBA APPROVAL RBL APPROVAL P.C.B.O.H. Rev. 10/18/04 DEPARTMENT OF HEALTH Division of Environmental Health Services 4 Geneva Road, Brewster, New .York 10509 (914) 278 -6130 :� >.,. -,�_. �.„ �, PAZ; ICA7''• 3�' ObT.:- TO.. �dNSTRt ,%e�''�7k�'�IA�b;��Tn1Ei�L �... ...�.. _ . _._.._....: *�:.- - �:��. =��' PCHD PERMIT # WELL LOCATION Street Address Town Vi lage City Tax Grid Number Msue}- , e, a- a -o WELL OWNER ame Mail ' ng A dress 'fiPrivate MN)_0 Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS ® INDUSTRIAL O PUBLIC SUPPLY O AIR /COND /HEAT PUMP O FARM O TEST /OBSERVATION O INSTITUTIONAL O STAND -BY O ABANDONED O OTHER (specify AMOUNT OF USE YIELD SOUGHT S gpm /# PEOPLE SERVED 5 /EST. OF DAILY USAGE 500 gal -'REPLACE EXISTING SUPPLY ® TEST /OBSERVATION GI ADDITIONAL SUPPLY ❑ NEW SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING , WELL TYPE •®DRILLED ®DRIVEN []DUG [)GRAVEL ®OTHER IS WELL SITE SUBJECT TO FLOODING? YES / NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. WATER WELL CONTRACTOR: Name Jl(� �e�l(X1 .WQ�� . Address: R�r sa Cpl �:�1' 10.SIa IS PUBLIC WATER SUPPLY AVAILABLE TO SITE YES NO NAME OF PUBLIC WATER SUPPLY: SA r W *J�T .,' 3QPR1, 4 TOWN /VIL /CITY DISTANCE_'TO - PROPERTY -'FROM° NEAREST.'WATER,--MALN&s -. -- :--( LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED M ON SEPARATE SHEET g -31-45 (date) (signa re) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt -y (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well drilling operations be contained on this property and in such a manner as not 'to. degrade or otherwise contaminate surface or groundwater. Date of Issue: 19 Date of Expiration 19 Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller A =+ OL/9 Boyd Artesian W_ ell Co., Inc.___ Carmel, N.Y. 10512 �Fo A (914) 225-3196 ABILITY P4 1jf- iV4 Af� /V. UJI 1) 1 � i 8 I /* 117 N. Sid S'Fp f-1 (- 5